Background. Inflammatory bowel diseases (IBD) are characterized by chronic immune inflammation of the mucous membrane and/or the thickness of the intestinal wall, and are also accompanied by disorders of the blood clotting system and the development of a hypercoagulation state. Aim. To identify the frequency of thromboembolic complications (TEC) in IBD patients and to determine the influence of acquired and inherited hypercoagulation factors that contribute to the development of TEС. Materials and methods. The clinical status of 1,238 IBD patients who were treated in 2019 was evaluated. Of these, 748 patients with ulcerative colitis (UC) and 490 patients with Crohn's disease (CD). Among UC patients, there were 369 (49.3%) men and 379 (50.7%) women. In 10.1% of patients with UC, there were clinically significant feasibility studies. There were 227 (46.3%) men and 263 (53.7%) women among patients with CD; 7.3% of patients with CD had clinically significant feasibility studies. Results. In general 112 (9.0%) of 1,238 IBD patients had clinically significant feasibility studies. Among patients with UC (n=748), 76 (10.2%) showed clinically significant feasibility studies. Among patients with CD (n=490), 36 (7.3%) had a feasibility study. Of 112 IBD patients with clinically significant TEC, 45 (40.2%) had genetic polymorphisms that increase affinity for fibrinogen, increase platelet aggregation, and contribute to a decrease in the activity of folate cycle enzymes, including methylenetetrahydrofolate reductase, which may be manifested by a moderate increase in homocysteine levels. Of the 45 IBD patients with clinically significant TEC due to inherited factors, 30 (66.6%) patients had UC, 15 (33.7%) patients had CD (hazard ratio 1.038, 95% confidence interval 0.7461.444; 2=0.049; p=0.83921); 67 (59.8%) patients with IBD who had clinically significant TEC did not have genetic polymorphisms leading to hypercoagulation. Conclusion. Based on the analysis, we can conclude that such risk factors for the development of TEC as the status of a smoker, long bed rest, taking hormonal contraceptives, varicose veins of the lower extremities, high activity of the disease, glucocorticoids therapy, the extent of intestinal damage in patients with IBD, genetic factors, should be taken into account by gastroenterologists in the treatment of patients with UC and CD. The hereditary factor of hypercoagulation equally affects the development of TEC, both in patients with UC and CD.

Cervical cancer (CC) is a serious health problem all over the world. CC is a fully preventable disease; however, it remains one of the leading causes of death among women with carcinomas. The screening helps to reduce morbidity and mortality. Two tests are used as screening tests in the world: сervical cytology and detection of human papillomavirus (HPV). Cervical cytology (Pap test) is a traditional test of CC screening. Two types of Pap test are used in modern laboratory practice: liquid and traditional methods. HPV testing is now used as the primary screening tool for СС in some countries. However, a key factor in effective screening is the coverage of the population and the organization of the screening. Immunocytochemical examination is an additional method used to improve the accuracy of diagnosis, p16/Ki-67 dual staining. This review focuses on the laboratory methods used in the world practice of screening. The literature search for this review was conducted using PubMed, MedLine and Embase.

A number of studies have found an association between the increased concentration of glial fibrillar acid protein (GFAP) in blood serum in patients with various types of brain damage (ischemic stroke, traumatic brain injury, neurodegenerative and neuro-oncological diseases), as well as with a rapid decline in cognitive functions in elderly people with initially normal cognitive abilities.The objective: to identify the relationship between delayed cognitive recovery and changes in serum GFAP concentration in the perioperative period in patients operated for various oncological diseases.Subjects and Methods. The study included 30 patients who underwent surgical treatment for prostate cancer, colorectal cancer and pancreatic cancer under combined general anesthesia.The inclusion criteria were the expected duration of the operation over 300 minutes and the age over 60 years. GFAP was determined in plasma by enzyme immunoassay before anesthesia, the next day after surgery and on the 4th–5th day. Neuropsychological testing was performed before surgery and on the 4th–5th postoperative day. Delayed cognitive recovery was defined as a decrease in the composite z-score of more than one standard deviation (SD) compared to the preoperative assessment.Correlation analysis was performed between changes in the composite z-score (in absolute values) and the difference in GFAP concentration between the outcome and the first postoperative day, the outcome and the 4th–5th postoperative day and the first and 4th–5th postoperative days.Results. In five cases (16.6%), a decrease in the composite z-score > 1 SD was revealed indicating a delayed cognitive recovery. In the remaining 25 (83.4%) patients, changes in the composite z-score were less than one standard deviation. The median concentration of GFAP in patients with delayed cognitive recovery was 0.13 [0.1; 0.14] before surgery, 0.12 [0.09; 0.14] the day after surgery and 0.16 [0.05; 0.19] on the 4th–5th day after surgery. In patients without cognitive impairment, the concentration of GFAP was 0.15 [0.125; 0.184] before surgery, 0.15 [0.121; 0.163] 24 hours after surgery and 0.13 [0.079; 0.151] on the 4th–5th day after surgery. The correlation values between changes in the composite z-score and the difference in GFAP concentrations were: between the outcome and the first postoperative day – rs = 0.107, p = 0.37, outcome and the 4th–5th postoperative day – rs = 0.134, p = 0.37, the first and 4th‒5th postoperative days – rs = 0.21, p = 0.37.Discussion. There was no statistically significant difference in GFAP levels between patients with delayed cognitive recovery and patients without cognitive impairment. There was also no correlation between the difference in GFAP concentrations in plasma before surgery and 24 hours after, before surgery and on the 4th–5th day of the postoperative period and the composite z-score.Conclusions. The use of GFAP to predict cognitive decline associated with surgical treatment of colorectal cancer, prostate cancer and pancreatic cancer under general anesthesia is not yet possible.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить возможность комплексной дифференциальной диагностики рака поджелудочной железы (РПЖ) и хронического панкреатита (ХП) с применением комбинации онкомаркеров РЭА, CA 19-9 и CA 242 и неинвазивной оценки микроциркуляторного русла при помощи мультиспиральной компьютерной томографии (МСКТ) с внутривенным контрастированием. МАТЕРИАЛ И МЕТОДЫ В исследование включены 193 больных РПЖ и ХП, проходивших обследование и лечение в отделении патологии поджелудочной железы и желчевыводящих путей ГБУЗ «МКНЦ им. А.С. Логинова ДЗМ» в 2017—2019 гг. РЕЗУЛЬТАТЫ Эффективность CA 19-9, CA 242 и РЭА как раздельно интерпретируемых биомаркеров, так и при их совместном использовании оценивали по кривым ROC. При сравнении групп РПЖ и ХП выявлено, что значения чувствительности равны 74%, специфичности — 92%, площадь под кривой (AUC) — 0,83 для CA 19-9; 60%, 82%, 0,71 для CA 242; 68%, 70%, 0,69 для РЭА. При подсчете параметров ROC-кривой при комбинации всех трех онкомаркеров выявлено увеличение AUC до 0,88; чувствительности до 84%, однако наблюдалось некоторое снижение специфичности по сравнению с определением только CA19-9 — 78%. В результате обработки результатов КТ выявлено, что среднее значение Mgrad у пациентов группы РПЖ статистически значимо выше (26,5±8,6 HU), чем у пациентов группы ХП (13,9±5,1 HU), p=0,0001. Анализ полученных значений Mgrad в исследованных группах позволил вычислить пороговое значение для дифференциальной диагностики РПЖ: Mgrad=20 HU. Массив значений Mgrad выше данного показателя статистически значимо чаще отмечен у пациентов с РПЖ (p=0,001). ЗАКЛЮЧЕНИЕ Совместное определение в сыворотке крови уровней онкомаркеров CA 19-9, CA 242 и РЭА имеет больший показатель чувствительности и значение AUC ROC-кривой, чем использование одного из указанных онкомаркеров для дифференциальной диагностики рака поджелудочной железы и хронического панкреатита. Мультиспиральная компьютерная томография с внутривенным контрастированием и оценкой Mgrad эффективнее, чем только мультиспиральная компьютерная томография с внутривенным контрастированием для дифференциальной диагностики рака поджелудочной железы и хронического панкреатита.

AIM:To conduct comparative analysis of histological remission in patients with moderate and severe ulcerative colitis (UC), receiving biological therapy vedolizumab, mesenchymal stem cell (MSC) treatment and combined stem cells and vedolizumab therapy.MATERIALS AND METHODS:We studied biopsies of 75 patients with total or left-sided moderate and severe ulcerative colitis, divided into groups depending on treatment. The first group of UC patients (n=29) received stem cell therapy 2 mln per kg; the second group of UC patients (n=27) received vedolizumab and the third group (n=19) MSC and vedolizumab. The efficacy of treatment was assessed by C reactive protein (CRP), Mayo score (MS), fecal calprotectin (FC) and Geboes score (GS).RESULTS:We determined medium correlation between basic FC and MS before treatment (r=0.6605, p0.05). After 12 weeks of treatment in the first group of UC patients (n=29) CRP was 7.82.1 mg/l, FC 409.344.85 g/g, medium GS 1.20.1 points. After 12 weeks of treatment in the second group of UC patients (n=27) CRP was 8.41.4 mg/l, FC 435.547.3 g/g, medium GS 1.350.15 points. After 12 weeks of treatment in the third group of UC patients (n=19) CRP was 6.41.1 mg/l, FC 290.617.5 g/g, medium GS 0.90.1 points. We proved strong direct relationship between FC and GS after 12 weeks of treatment in UC patients, receiving MSC (r=0.8392, p0.05). The statistically significant majority of patients, achieved histological remission, have less than 5-year duration of disease.CONCLUSION:Our study showed that clinical and endoscopic remission in UC patients does not always correlate with histological remission. Combined anti-cytokine and stem cells therapy contributes to achieve deep remission and decrease mucosa inflammation rather than single MSC or vedolizumab treatment. Deep remission could be achieved by earlier start of biological therapy. FC could be a predictor and marker of mucosa healing and histological remission.

Aim. To determine the frequency of celiac disease (CD) among gastroenterological patients and criteria for its active detection. Materials and methods. 1.358 patients referred for gastroenterologist consultation from 2016 to 2019 was conducted, of which 140 had CD (339 males 24.9%; 1019 females 75.1%). The average age was 40.415.4 (1886 years). All patients were determined anti-TTG IgA, IgG, and analyzed the clinical symptoms and analysis. The results were subjected to statistical processing Statistica 13.3 (StatSoft Inc., USA). Results. In patients without CD (1218 people), high level of anti-TTG IgA and IgG was observed in 59 (4.8%), an increase in anti-TTG IgA in 54 (4.4%), and anti-TTG IgG in 38 patients (3.1%). The CD diagnosis confirmed in 51 patients (4.2%). The main symptoms were diarrhea (88%), abdominal pain (60.7%), bloating (73.8%), nausea (40.3%), weight loss (44.3%). Anemia was determined in 31.6%, serum iron 33%, hypoproteinemia 12.6%, hypoalbuminemia 12%, hypokalemia 5.48%, hypocalcemia 21.9%. An increase in the level of AST 14.5%, ALT 14.6%. Comparative analysis showed that in the group with newly detected CD, anemia, malabsorption syndrome, increase AST, ALT were significantly more frequent than in patients with normal antibodies, which confirms the need to detect CD among patients with these laboratory abnormalities. Conclusion. The incidence of CD among patients with a gastroenterological symptoms was 4.2%. Analysis of clinical and laboratory data has shown that a comprehensive analysis of clinical symptoms and laboratory indicators at the stage of primary treatment will allow timely identification of CD patients and prescribe GFD.

Цель. Определить частоту целиакии среди больных с патологией органов пищеварения и критерии ее активного выявления. Материалы и методы. Обследованы 1358 больных, направленных к гастроэнтерологу с 2016 по 2019 г., из них 140 – с установленной ранее целиакией, мужчин – 339 (24,9%), женщин – 1019 (75,1%). Средний возраст составил 40,4±15,4 года (18–86 лет). Всем больным определяли антитела к тканевой трансглютаминазе (IgA, IgG АТ тТГ), а также анализировали клинические симптомы и лабораторные показатели. Результаты подвергали статистической обработке с помощью программы Statistica 13.3 (StatSoft Inc., США). Результаты. Из числа обследованных больных без целиакии (1218) повышение уровня АТ тТГ IgA и IgG отмечено у 59 (4,8%), повышение АТ тТГ IgA – у 54 (4,4%), а АТ тТГ IgG – у 38 (3,1%) больных. Впервые диагноз целиакии установлен у 51 (4,2%) пациента. Основными симптомами являлись диарея (88%), боли в животе (60,7%), вздутие и урчание в животе (73,8%), отрыжка воздухом и тошнота (40,3%), снижение массы тела у 44,3%. Снижение гемоглобина определялось у 31,6% больных, гипоферремия – 33%, гипопротеинемия – 12,6%, гипоальбуминемия – 12%, гипокалиемия – 5,48%, гипокальциемия – 21,9%, повышение уровня печеночных трансаминаз – у 14% больных (аспартатаминотрансфераза – 14,54%, аланинаминотрансфераза – 14,6%). У больных с впервые выявленной целиакией достоверно чаще, чем у больных с нормальными показателями АТ тТГ, наблюдались лабораторные признаки мальабсорбции и повышение маркеров, что подтверждает необходимость выявления целиакии среди пациентов с указанными лабораторными отклонениями. Заключение. Частота целиакии среди больных гастроэнтерологического профиля составила 4,2%, что выше, чем в общей популяции (1%). Комплексный анализ клинических симптомов и лабораторных показателей позволяет выявлять больных целиакией на этапе первичного обращения к врачу и назначать этиотропное лечение.

The article presents a clinical case of a prolonged course of gastrointestinal ulcer disease, followed by dysphagia. During the examination, severe hyperparathyroidism was revealed, which subsequently prompted a diagnostic search for a parathyroid adenoma, which is the cause of hyperathyroidism in 8085% of cases. With instrumental methods of research, the cause of the main complaint is dysphagia, a formation in the posterior upper mediastinum up to 5 cm, compressing the esophagus. With transoesophageal aspiration biopsy (EUS-TYPE). The cytological picture is similar to the thyroid epithelium with part of the oncocytic differentiation. In an immunological study, lavage for parathyroid hormone showed high expression. Scintigraphy with Tc-99m pertechnetate revealed the exact topic of the formation of the parathyroid gland in the posterior mediastinum an atypical location. Surgical treatment was performed in the amount of thoracoscopic removal of the mediastinal tumor. The radical nature of the surgical intervention was confirmed by laboratory. Serum PTH levels decreased significantly. Upon receipt of the morphological conclusion, reliable data on malignant damage to the parathyroid gland were obtained. Subsequent treatment of the patient consisted in the correction of severe hypercalcemia in the postoperative period by prescribing denosumab, which led to the stabilization of the patients condition.

Представлен клинический случай длительного течения язвенной болезни желудочно-кишечного тракта с последующим проявлением дисфагии. В ходе обследования у пациента выявлен тяжелый гиперпаратиреоз, что натолкнуло на диагностический поиск аденомы околощитовидной железы, которая является причиной гиперпатиреоза в 80–85% случаев. Инструментальными методами исследования выявлено, что причиной основной жалобы – дисфагии – явилось образование в заднем верхнем средостении до 5 см, сдавливающее пищевод. При транспищеводной аспирационной биопсии: цитологическая картина, сходная с тиреоидным эпителием с частью онкоцитарной дифференцировки. При иммунологическом исследовании смыва на паратиреоидный гормон выявлена высокая экспрессия исследуемого показателя. Сцинтиграфия с 99m Тс-пертехнетатом выявила точную топику образования околощитовидной железы в заднем средостении – атипичное расположение. Проведено хирургическое лечение в объеме торакоскопического удаления опухоли средостения. Радикальность оперативного вмешательства подтверждена лабораторно. Уровень паратиреоидного гормона в сыворотке крови значительно снизился. При морфологическом заключении получены достоверные данные о злокачественном поражении околощитовидной железы. Последующее лечение пациента заключалось в коррекции тяжелой гиперкальциемии в послеоперационном периоде путем назначения деносумаба, что привело к стабилизации состояния.

Presented the case of complex examination of a patient with pancreatic cancer using a bioimpedance method for assessing the nutritional status before and after surgical treatment. Provided the literature data related to this problem. The presented clinical case demonstrates the features of correction of the nutritional status of a patient with conditionally resectable pancreatic cancer in conditions of cholestasis, severe external pancreatic insufficiency and pancreatogenic diabetes mellitus on the background of constitutional obesity

AIM To compare fecal calprotectin (FC) concentration with laboratory and diagnostic methods in patients with inflammatory bowel diseases (IBD). MATERIALS AND METHODS The level of FC was measured in 110 patients with established IBD. Crohn diseases (CD) was diagnosed in 50 patients, ileocolitis - in 38 and terminal ileitis in 12 individuals. Ulcerative colitis (UC) was diagnosed in 60 patients, total colitis in 35, left-side colitis in 21 and 4 patients have proctitis. Laboratory data include measurement of FC, leukocytes, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), fecal occult blood. All patients underwent colonoileoscopy (CIS) at the start of disease flare and after 12 weeks of treatment. RESULTS We found linear correlation between level of FCP and endoscopic activity of CD, analyzing FCP level and endoscopic activity of CD before (during disease flare) and after 12 weeks treatment (r=0.66, p<0.001). Linear correlation between FCP and SES-CD sustained after 12 weeks of treatment (r=0.77, p<0.001). We revealed correlation between FCP concentration. And CRP level (r=0.59, p<0.05). The linear correlation was detected between FCP and endoscopic activity of UC (r=0.88, p<0.001) before the treatment. After 12 weeks of treatment linear correlation was shown between FCP and Meyo scale (r=0.73, p<0.001). IBD patients with FCP more than 200 mcg/g have high risk of disease reccurence in short-term period of time (HR - 8.33; 95% CI 2.05-33.8; χ2 - 11.85; p<0.001) and (HR - 2.7; 95% CI 1.1-6.6; χ2 - 5.3; p<0.05), accordingly. CONCLUSION Increased FCP level indicates poor effectiveness of treatment and high risk of reccurence. The level of FCP correlates strongly with recent laboratory and diagnostic indices of activity and enables to determine patients with high risk of reccurence. Thus, thorough monitoring, including additional procedures, contributes to just-in-time treatment modification.

Aim. To study the possibilities of endoscopic ultrasonography with contrast enhancement and fine-needle biopsy in the diagnosis of metastatic lesions of the pancreas. Materials and methods. 299 patients with solid pancreatic neoplasms were examined in the period from 2016 to 2018. Among them, adenocarcinoma of pancreas was diagnosed in 96.3% (n= 288), in 3.7% of cases (n= 11) a secondary lesion of the pancreas was suspected due to the presence of a tumor of another localization. Endosonography with contrast enhancement and fine-needle biopsy was performed for all these patients. Results. In 7 of 11 patients, there was a primary lesion of the pancreas (ductal adenocarcinoma), confirmed by morphological research data from a fine-needle biopsy. Of the 11 cases, the metastatic lesion of the gland was morphologically verified in 4 (36.4%) cases. In 2 cases, metastases of renal cell carcinoma were diagnosed, 1 was metastasis of small cell lung cancer, and 1 was metastases of colorectal cancer. Patients with secondary lesions of the pancreas accounted for 1.3% of the total number of patients. Conclusion. In the presented clinical observations, the possibilities of endo-ultrasound with contrast enhancement were analyzed, as well as the prospect of cytological and immunocytochemical studies in situations where the material obtained during fine-needle puncture is insufficient for histological examination. Such an approach is fully justified and helps to clarify the nature of the neoplasm in difficult situations.

Aim. To study the possibilities of endoscopic ultrasonography with contrast enhancement and fine-needle biopsy in the diagnosis of metastatic lesions of the pancreas.Materials and methods. 299 patients with solid pancreatic neoplasms were examined in the period from 2016 to 2018. Among them, adenocarcinoma of pancreas was diagnosed in 96.3% (n= 288), in 3.7% of cases (n= 11) a secondary lesion of the pancreas was suspected due to the presence of a tumor of another localization. Endosonography with contrast enhancement and fine-needle biopsy was performed for all these patients.Results. In 7 of 11 patients, there was a primary lesion of the pancreas (ductal adenocarcinoma), confirmed by morphological research data from a fine-needle biopsy. Of the 11 cases, the metastatic lesion of the gland was morphologically verified in 4 (36.4%) cases. In 2 cases, metastases of renal cell carcinoma were diagnosed, 1 was metastasis of small cell lung cancer, and 1 was metastases of colorectal cancer. Patients with secondary lesions of the pancreas accounted for 1.3% of the total number of patients.Conclusion. In the presented clinical observations, the possibilities of endo-ultrasound with contrast enhancement were analyzed, as well as the prospect of cytological and immunocytochemical studies in situations where the material obtained during fine-needle puncture is insufficient for histological examination. Such an approach is fully justified and helps to clarify the nature of the neoplasm in difficult situations.

In the literature there is little information about the occurrence of dielectrolytes with inadequately selected parenteral-enteral correction. This fully applies to the correction of iron deficiency in colorectal cancer (CRC). Material and methods. On examination were 51 patients with CRC (T3N1M0 and T4N0M1) and iron deficiency of various severity. Nutritional status was assessed by the parameters of a known alimentary-volemic diagnosis (AED). Iron deficiencies resulting from chronic blood loss were assessed by the content of serum iron, ferritin, transferrin, the level of Hb and Ht, the number and average volume of red blood cells, and the average content of Hb in the red blood cell. The control group consisted of 10 patients with iron-deficient anemia. Results. One of the components of the AVD is the determination of electrolyte deficiencies, including gland. With a deficit of free iron in plasma up to 11%, a decrease in hemoglobin level and Ht, a slight decrease in the number of erythrocytes and normal parameters of ferritin, the average volume of erythrocyte and the content of Hb in it were sufficient nutritive correction mixtures containing 3.0-3.5 mg of iron in 100 g dry product. With a higher iron deficiency, additional parenteral administration of its drugs was required: as part of the nutritional correction, as a pharmacological supplement, supplements were injected with non-sorbed or sorbed iron on a special matrix (ironMatrix), which guaranteed the stability of the iron complex and its controlled release in the body. At the same time, sorbed iron provided a higher safety (no complications were observed in any of the studies. with the administration of non-sorbed iron in 2 cases, there were unpleasant sensations in the heart area, in the right hypochondrium, resembling signs of iron overload (ferritin could increase to 1340 mg), stopped, however, only by the administration of a hepatoprotector and 0.9% of the sodium chloride solution without the additional use of an antidote. Conclusion. For the sake of safety of iron deficiency correction (prevention of toxic-metabolic complications) when conducting a comprehensive nutritional correction in patients with CRC complicated by mild chronic anemia with iron deficiency not more than 11%, it is advisable to use drugs containing iron (3-3.5 mg per 100 g of dry product), and in case of a pronounced shortage of it, supplement the nutritional support with parenteral preparations of sorbed iron under the control of the parameters of iron metabolism.

Treatment of iron deficiency conditions by nutritive support media is one of the debatable areas. In the analysis of nutritional status, nutritional risk and ferrumdeficiency parameters in patients with operated colorectal cancer in different stages, the possibility of correction of prelatent and latent iron deficiency with ferrum‑containing media of nutritional alimentation is shown. With the development of anemia, the use of с intravenous correction (preferably with drugs sorbed on a special matrix that allows the gland to be isolated in portions) is shown.

In the literature there is little information about the occurrence of dielectrolytes with inadequately selected parenteral-enteral correction. This fully applies to the correction of iron deficiency in colorectal cancer (CRC). Material and methods. On examination were 51 patients with CRC (T3N1M0 and T4N0M1) and iron deficiency of various severity. Nutritional status was assessed by the parameters of a known alimentary-volemic diagnosis (AED). Iron deficiencies resulting from chronic blood loss were assessed by the content of serum iron, ferritin, transferrin, the level of Hb and Ht, the number and average volume of red blood cells, and the average content of Hb in the red blood cell. The control group consisted of 10 patients with iron-deficient anemia. Results. One of the components of the AVD is the determination of electrolyte deficiencies, including gland. With a deficit of free iron in plasma up to 11%, a decrease in hemoglobin level and Ht, a slight decrease in the number of erythrocytes and normal parameters of ferritin, the average volume of erythrocyte and the content of Hb in it were sufficient nutritive correction mixtures containing 3.0-3.5 mg of iron in 100 g dry product. With a higher iron deficiency, additional parenteral administration of its drugs was required: as part of the nutritional correction, as a pharmacological supplement, supplements were injected with non-sorbed or sorbed iron on a special matrix (ironMatrix), which guaranteed the stability of the iron complex and its controlled release in the body. At the same time, sorbed iron provided a higher safety (no complications were observed in any of the studies. with the administration of non-sorbed iron in 2 cases, there were unpleasant sensations in the heart area, in the right hypochondrium, resembling signs of iron overload (ferritin could increase to 1340 mg), stopped, however, only by the administration of a hepatoprotector and 0.9% of the sodium chloride solution without the additional use of an antidote. Conclusion. For the sake of safety of iron deficiency correction (prevention of toxic-metabolic complications) when conducting a comprehensive nutritional correction in patients with CRC complicated by mild chronic anemia with iron deficiency not more than 11%, it is advisable to use drugs containing iron (3-3.5 mg per 100 g of dry product), and in case of a pronounced shortage of it, supplement the nutritional support with parenteral preparations of sorbed iron under the control of the parameters of iron metabolism.